Thursday, September 2, 2010

I don't do that much teaching anymore. I like it, but the constraints of time with a family and solo practice make it damn near impossible.

But I still do it, albeit rarely, on special requests from friends, nurses or docs I know, etc. And yesterday was one of those days.

I got my start in a college program where I shadowed docs to see if I wanted to be one, and so I have a tender spot for those kids. Last week one of the hospital nurses called me. Her son is in his 2nd year of college, and is thinking about medicine. She was calling around to see if anyone would let him watch for a day. And since I'm a softy, I said sure.

He shows up, neatly dressed, trying to look young, eager, and professional. My first patient was in for an EMG (electrical test of the nerves and muscles), and she didn't have a problem with the student watching.

I fired up the machine, and made some notes. Joe College leaned over my shoulder to see what I was doing. I stuck a needle in the patient's deltoid, and turned to the machine to look at the results.

There was a loud "thunk" behind me. The patient and I both turned to see Joe College sprawled unconscious on my exam room floor.

The patient began laughing. I pulled the needle out of her arm and called Mary for help. We got Joe out to the break room as he woke up, and got him some water.

By the time I was done with the EMG he was gone. He'd told Mary he was thinking about becoming a pharmacist or accountant. He also asked for her phone number.

Brings back memories....of being in a Medical Explorers' high school club - filled with pre meds and lots of MD offspring. Two lasting lessons: taught everyone how to recognize impending LOC and how to valsalva or get the hell outta Dodge before going to ground. We were threatened with bodily harm if we didn't fully control ourselves and inadvertently contaminate something in the OR.

And the second - the only kid to go to ground was a sadistic doc's unfortunate son during our observation of an autopsy. Probably saved him from enduring more haranguing from his dad to follow in the family med tradition, though.

That is exactly why I decided to go into pharmacy. Although as a clinical pharmacist in a trauma center hospital, I have toughened up a lot in 15 years. I don't pass out anymore, just get light-headed when there are mass amounts of blood.

I think my favorite medical procedure = floor situation is this: I know a medic who is great at what he does, doesn't flinch in the face of blood and guts, and only really has issues with vomiting or diarrhea.

Until you stick him with the needle. Draw his blood or do an IV and he will hit the ground in no time flat :)

My second favorite is a medic who if he sees blood in the ER will hit the floor, but throw it in the back of an ambulance with him and he can take it all day. :)

Poor kid. The only time I ever came close to hitting the ground was when I was assisting in a dorsal slit of a foreskin. The procedure didn't bother me at all - the patient sitting up, talking and giving running commentary got to me. I really wanted to look up at him and say, "just shut the hell up already!" When you're doing *that* *down there*, the patient should not be watching and making comments.

And kuddos to you for letting people shadow you. That is awesome. When I was growing up and wanted to be a doctor, my dad found a pathologist for me to shadow...boring! We must have looked at hundreds of slides.

Anyways, I quickly realized that the blood and guts side of medicine was not for me and ended up in....pharmacy! Still have the occasional kid barf in the waiting area or the deli employee slice their finger open, but for the most part, everyone's wounds are nicely bandaged and stowed away before they get to me. I don't mind hearing about the diarrhea, vomiting, etc....I just don't want to see it.

Ha! I *had* an EMG recently, and a local high-school student who was thinking of going into medicine was there, and they asked me if I minded if he observed. It was fine with me. *This* kid had no trouble watching quietly as I got stabbed and electrocuted (FOR SCIENCE!). If he'd fainted, yeah, I'd have laughed like hell too.

We had to do blood glucose testing in pathology labs (in pharmacy school - yes, another pharmcist!), but I begged out because of my knack for passing out at the sight of my own blood. The TA gave me a really hard time about it so the girl across the bench from me didn't say anything. Guess who had to be taken out into the hall for deep breathing when she passed out and fell off her stool.

If you guessed the TA, you would be correct. I ended up looking after my unconscious classmate and assigning other classmates to remove the panicky TA from the room...

I see needles in pharmacy alot. And work with them, too in the hospital. Stabbed myself in the fingers a few times (and yes, bicard does cause a wee bit of skin breakdown in concentrated form). Just saying, he might not be up for pharmacy either.

My 1st day as an actual Air Force Medical Specialist was in labor and delivery at the Chanute Air Force Base hospital in Illiois. I was 18 years old. Having grown up on a farm, I had seen every kind of animal give birth. The training films we were shown were very gaphics. I was prepared.

As a patient, I was having a core breast biopsy. While the radiologist was inserting the wires in during the mammogram, I started to go because of the pain of the mammogram. While the 4'8 radiologist was trying to hold me up while someone find a high enough stool for me, a med student went hit the floor. At the end the radiologist commented that we had made her day. She's had patients keel over and students keel over but this was the first both went simultaneously.

Rotations at a hospital doing wound rounds with the dietitian intern and the "real" staff.

Post total knee replacement with drainage hole (it was infected, so they had to put tobramycin impregnated disks in the knee). Doc flexed the knee and a turbid sweet-smelling fluid shot out of the drainage hole and shot about 4 feet. This was after he removed a ton of packing gauze like a clown pulling 4 feet of ribbon out of his mouth.

Dietitian intern when down. I was rock solid. Our preceptors made a bet as to who would pass out first. I won lunch for the pharmacy staff.

For the rest of my slave-work there, they were determined to get me to pass out. Central lines, blood splattering, nada.

As a medical student blood is fine, dead bodies are fine, urine is fine, needles are fine, csf is fine, amniotic is fine.

What is less fine is sputum. It doesn't make me faint but it will make me want to suppress dry gagging.

What will make me light headed is standing around a patient bed with 10 medical students and a doctor, while the curtain is closed and I'm standing in a position where the curtain is basically a blanket, in a ward that is on the 2nd highest (warmest) floor of the hospital, and the patient has neurology problems meaning they have just soiled themselves so that smell (their diet must have been terrible by the smell) filled the air (and not helped by the warmth of the air).

I didn't drop, but quickly made for the toilet where I got fresh air and a seat to then recover and pretend I just needed to do what the patient clearly had just done.

During SARS, I had to put on the much hated N95 mask while reviewing the medication charts of my paeds patients. I was near the end of my 1st trimester and had been a pious devotee of the god-of-the-toilet-bowl. I'm usually fine with blood, suctions, even those horrid bedsores. Unfortunately, coupled with the N95, with it's distinctive fibre smell... I was reviewing orders in the paeds medical high-dependency cubicle when the nurses started suctioning a paliative patient... The smell (of the mask) coupled with the sounds of suctioning, both the machine and the gargling sound, sent me fleeing to the sink to (my god, the toilet bowl was too far away for my salvation)...

I always liked the muscle-twitching part of EMGs. The needles never bothered me (many years of donating blood and getting allergy shots), and the neurologists were always interesting to talk to.

The process reminded me of attaching electrodes to the legs of the frogs we dissected in high school biology. (Sorry, we didn't use jumper cables like stupid kid from the other day, just alligator clips hooked up to 9v batteries.)

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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